Secondary Primary Malignancy Risk in Patients With Cervical Cancer in Taiwan

Abstract

To evaluate the risk of secondary primary malignancy (SPM) in patients with cervical cancer using a nationwide population-based dataset.Patients newly diagnosed with cervical cancer between 1997 and 2011 were identified using Taiwan's National Health Insurance database. Patients with antecedent malignancies were excluded. Standardized incidence ratios (SIRs) for SPM were calculated by comparing with the cancer incidence in the general population. Risk factors for cancer development were analyzed using Cox proportional hazard models.During the 14-year study period (follow-up of 223,062 person-years), 2004 cancers developed in 35,175 patients with cervical cancer. The SIR for all cancers was 1.56 (95% confidence interval, 1.50–1.63, P < 0.001). SIRs for follow-up periods of >10, 5 to 10, 1 to 5, and <1 year were 1.37, 1.51, 1.34, and 2.59, respectively. After the exclusion of SPM occurring within 1 year of cervical cancer diagnosis, SIRs were significantly higher for cancers of the esophagus (2.05), stomach (1.38), colon, rectum, and anus (1.36); lung and mediastinum (2.28), bone and soft tissue (2.23), uterus (3.76), bladder (2.26), and kidneys (1.41). Multivariate analysis showed that age ≥60 was a significant SPM risk factor (hazard ratio [HR] 1.59). Different treatments for cervical cancer, including radiotherapy (HR 1.41) and chemotherapy (HR 1.27), had different impacts on SPM risk. Carboplatin and fluorouracil independently increased SPM risk in cervical cancer patients.Patients with cervical cancer are at increased risk of SPM development. Age ≥60 years, chemotherapy, and radiotherapy are independent risk factors. Carboplatin and fluorouracil also increased SPM risk independently. Close surveillance of patients at high risk should be considered for the early detection of SPMs.

Incidence of second primary malignancy after breast cancer and related risk factors—Is breast‐conserving surgery safe? A nested case–control study

“…Although breast‐conserving surgery plus radiotherapy played an important part in the management of BC, complications remain a troubling by‐product. Some studies demonstrated an association between radiotherapy and the elevated risk of subsequently SPM among patients with prostate and cervical cancers . A secondary malignancy induced by initial treatment represents one of the most serious complications.…”

Gastric metastases from gynaecologic tumors: case reports and review of the literature

“…Synchronous or metachronous presence of primary gastric cancer and primary gynaecological tumor (ovary, uterus, and breast) has been described in 15 (0.6%) cases out of 2,668 patients with gastric cancer (34). Of note, it has been also found that patients with a personal history of uterine cancer are at 1.38-fold (95% CI: 1.09-1.72) increased risk of developing primary gastric cancer (35). Finally, women with hereditary inactivating mutations in the E-cadherin gene CDH1 are at increased risk for both gastric cancer and breast carcinoma (6).…”

Secondary uterine carcinosarcoma after concurrent chemoradiotherapy for cervical cancer: Case reports

“…On the other hand, Teng et al reported that a significantly higher risk was observed for secondary cancers of the uterus (Teng et al, 2015). In a report from Japan, a site-based analysis revealed an excess of second cancers in the rectum and uterine body and occurrences of acute leukemia (Ota et al, 2007).…”